COVID-19 Post-Vaccine Questionnaire

Thank you for participating in the COVID-19 vaccine study. Please fill out the post-vaccine questionnaire below.

COVID-19 Post-Vaccine Study Questionnaire

Your Contact Information

Vaccination Information

Have you already participated or are you scheduled to participate in the COVID-19 vaccine study? (Sterling IRB ID: 8291-BZhang)
Have you completed all COVID-19 vaccine doses?
Have you received a COVID-19 booster shot?

Important! This questionnaire should be completed at least 1 week after receiving the final COVID-19 vaccine dose or at least 5 days after receiving the COVID-19 booster shot.

Side Effect Information

Pain

Rash or Swelling

Neurological

Gastrointestinal

Pain

Rash or Swelling

Neurological

Gastrointestinal

Pain

Rash or Swelling

Neurological

Gastrointestinal

By clicking the “Submit” button below, I certify that the above answers are true to the best of my knowledge.